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Insect venom shortage stings allergy sufferers this summer

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As summer begins, signaling peak time for insect stings, allergists across the U.S. are warning of a shortage of a little-known but crucial product — honeybee, hornet and wasp venom extracts used in shots that prevent life-threatening reactions.

Supplies of the extracts — which are made from venom gathered by hand from millions of individual insects — have been scarce since October. That’s when one of two manufacturers in the U.S. shut down production after contamination problems. Doctors say they hope the situation will be resolved, but that’s not likely before next year. For now, they’re rationing doses for patients who need them most.

“It’s going to be a rough summer,” said Dr. David Golden, an allergy expert and associate professor of medicine at Johns Hopkins University.

Golden estimates he’s seen a 25 to 35 percent drop in the supply of venom extracts aimed at preventing dozens, perhaps hundreds, of deaths in the U.S. each year. Between 1 and 3 percent of the country’s adult population — up to 7.4 million people — may have systemic reactions to insect stings, and a smaller proportion have life-threatening responses, experts say.

Most of those vulnerable people carry portable epinephrine — often EpiPens — to quickly counteract symptoms. But a smaller number use what’s known as venom immunotherapy, or VIT, to dramatically reduce the risk of reactions. The treatment, authorized for nearly 40 years, injects small doses of venom under the skin to reduce sensitivity to the allergens that can trigger dangerous symptoms.

“It’s one of the few things that allergists do that actually save lives,” said Dr. Stephen Tilles, a Seattle allergist who is president of the American College of Allergy, Asthma and Immunology (ACAAI). “It’s about 98 percent effective.”

The shortage started last fall, when ALK Laboratories of Denmark shut down production of six types of venom proteins — honeybee, wasp, white-faced hornet, yellow hornet, yellow jacket and “mixed vespid,” a cocktail of venoms.

The move followed a 2016  letter from the Food and Drug Administration citing problems with microbiological contamination. ALK officials didn’t respond to requests for comment.

That left only Jubilant HollisterStier, a Spokane, Wash., company that also produces venom extracts. HollisterStier ramped up manufacturing, Golden said, but the firm couldn’t supply enough venom extract fast enough to avoid a shortage. Firm officials declined to comment.

“Most allergists are having to seriously limit what they use,” Golden said. “We’re trying to stretch the venom that we have.”

This spring, Golden and colleagues issued recommended guidelines for rationing venom during the shortage. They called for spacing out doses at longer intervals, cutting maintenance doses, minimizing venom waste — and stopping treatment for patients at lowest risk for severe reactions.

So far, the plan appears to have worked, said Dr. Sandra Hong, an allergist with the Cleveland Clinic. Most patients do fine with shots at longer intervals; instead of every four weeks, they get them every three months. And after three to five years of treatment, many can be weaned from the venom with no ill effects.

“With all the things the allergists have done, it has decreased the shortage,” Hong said.

There have been a few reports of allergists who couldn’t get supplies of venom, and patients who couldn’t get the product, which costs about $70 for induction doses and about $20 for each maintenance dose. So far, there are no known cases of adverse events in patients who couldn’t get shots. There’s also no sign of the skyrocketing drug prices that have occurred with other products in short supply.

Still, allergists worked to ensure that patients at the highest risk weren’t harmed. That includes people like Ciro DeMarco, 58, a retired machinist from Moxee, Wash.

DeMarco nearly died in 1983 after he was stung by a honeybee while riding a motorcycle near a river in rural eastern Washington.

“I started feeling real strange,” he recalled. “I stopped the motorcycle and sat down. All of a sudden, I had no sight and I was almost unconscious.”

He lived in fear of another sting until about 10 years ago, when he learned about VIT. Now he gets regular venom shots every three months and takes over-the-counter allergy medications before he climbs onto his Harley-Davidson. He’s relieved that the shortage hasn’t affected his supply.

“Every spring I worry about it,” he said. “But I’m not going to quit riding just in case I get stung.”

ALK Laboratories may resume production soon and the shortage could be eased in coming months. Once the supply question is resolved, Golden said, he hopes to tackle a larger issue: lack of VIT awareness among people who’ve had a bad reaction to an insect sting.

“No more than 10 percent of the affected people have sought medical attention,” he said. “Problem No. 1 is that many people, including doctors, don’t know venom immunotherapy exists.”

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Push to legalize marijuana upends governor’s race in New Mexico

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ALBUQUERQUE, N.M. — Democratic gubernatorial candidate Jeff Apodaca on Thursday called for the expansion of New Mexico’s medical marijuana program and for legalization of recreational use, saying the poverty-stricken state is missing out on millions of dollars in tax revenues and jobs that could be spurred by the industry.

Apodaca released his plan solidifying his position as a supporter of legalization as the race for governor heats up.

Apodaca pointed to New Mexico’s history as the first state to allow for research and experimentation with marijuana as a therapeutic drug. It was his father, then-Gov. Jerry Apodaca, who signed that legislation in 1978.

The research program stalled and it wasn’t until 2008 that New Mexico rolled out its medical cannabis program.

“Why are we shooting for being the last to legalize cannabis for adult use?” Apodaca said.

The push for legalization comes as New Mexico’s medical marijuana program has grown exponentially in just the last two years. Producers licensed under the program reported record sales of more than $86 million in 2017 and the number of patients enrolled now tops 50,000.

“We know the medical benefits of it. And we also know the opportunities of legalization for adult use,” Apodaca said, suggesting expansion of the long-standing medical marijuana program along with legalization could result in an estimated $200 million of additional tax revenues for the state.

The state’s largest producer, Ultra Health, announced that it has acquired farmland in southern New Mexico and has plans for what the industry says could be the largest cultivation facility in North America.

The property spans nearly one-third of a square mile (81 hectares) in Otero County. It will include 20 acres (8 hectares) of indoor cultivation, 80 acres (32 hectares) of outdoor cannabis fields and another 100 acres (40 hectares) of outdoor hemp fields.

Ultra Health president and CEO Duke Rodriguez said the company is preparing for a future in which New Mexico stands to benefit from expanded medical use and possibly recreational use.

Apodaca’s plan calls for lifting the current limits on the number of plants producers can grow and reducing costly licensing fees.

Other Democratic candidates have been more cautious.

U.S. Rep. Michelle Lujan Grisham said she would work with state lawmakers to ensure there are adequate health, safety and enforcement measures in place. She called for a “thorough analysis” of recreational pot programs in other states as part of that effort.

Lujan Grisham was in charge of the state Health Department when the medical marijuana program began. Aside from the legalization debate, she said supporting producers to create the latest medicines and methods to help patients would help create jobs and expand the industry.

State Sen. Joseph Cervantes, another Democratic candidate, has sponsored unsuccessful legislation to decriminalize possession of small quantities of pot but has said the state is lacking infrastructure and isn’t ready yet to legalize.

Cervantes recently lauded efforts at the local level by the state’s largest city — Albuquerque — to decriminalize possession of small amounts. He said he would do the same as governor and that it would mark a first step.

Republican congressman and gubernatorial candidate Steve Pearce expressed reservations about legalization at a forum earlier this month. He said it might create a stumbling block for people trying to climb out of poverty and addiction to other drugs.

“I just don’t see how it fits that we’re going to deal with addiction and yet we’re going to tell people, ‘This one is OK.’ I’ve watched it for a lifetime. I just am very nervous with recreational marijuana,” he said.

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‘For fun’ killing reveals vulnerability for homeless Native Americans in New Mexico

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The morning a homeless man was shot and killed in Albuquerque, police say surveillance videos showed him running down a street before sunrise, and then gunfire flash in the dark.

Native Americans make up only 4 percent of the population, but account for 44 percent of people living on the streets, raising the likelihood they will be victimized when there is an attack on the homeless.

Ronnie Ross, a 50-year-old from the Navajo Nation town of Shiprock, had been shot a dozen times, including once in the forehead and temple, and four times in the back, according to a criminal complaint. Police say the two teenage suspects charged with murder this week apparently shot him “for fun” as they came and went from a hotel party nearby.

The homicide marked the latest in a series of brazen killings and assaults of homeless Native Americans in the city. In Albuquerque, Native Americans make up only 4 percent of the population, but account for 44 percent of people living on the streets, raising the likelihood they will be victimized when there is an attack on the homeless.

A 2014 survey showed 75 percent of homeless Native Americans in Albuquerque had been physically assaulted.

“Just being harassed is part of everyday life, but it’s not as much harassment as it is overgrown bullying,” said Gordon Yawakia, who works at the Albuquerque Indian Center and was once homeless himself. “What do you do when people are against you and then the authorities are against you and you’ve got nobody, you know?”

In 2014, Allison Gorman and Kee Thompson, both Navajo, were beaten to death as they slept in a vacant lot. While authorities did not say the men were targeted because they were Native American, activists disagreed and the deaths spurred the creation of a city task force to address Native American homelessness that now-former Mayor Richard Berry said could set the stage for changes for the population across the Southwest.

Now, Ross’ death is underscoring how difficult it may be to protect and find solutions for the city’s Native American homeless population.

“When I hear a story like this it adds fuel to the fire,” said Dawn Begay, who is the city’s tribal liaison, and works with the homeless through a local nonprofit. “Where we’re headed is a good direction but it has to happen faster.”

Ross’ killing in March came three months after the body of Audra Willis was found decapitated in an area not far from the Sandia Mountains that line the city’s east side. The 39-year-old had come from To’hajiilee, a tiny Navajo community west of Albuquerque, and records show she had multiple addresses during her time in the city, including at the Albuquerque Indian Center.

Willis’ especially grisly death sent shockwaves through Albuquerque, just as the beatings of Thompson and Gorman had three years earlier.

The two men had been killed on a July 2014 night when authorities say three boys — ages 15, 16 and 18_returned home from a night of drinking and decided to attack them as they slept on a mattress. The men were beaten with a wooden table leg, cinder blocks, and other objects, police said. One young suspect later told authorities that the teens had beaten dozens of homeless people, though apparently none others fatally.

In Ross’ death, the complaint filed against the 15- and 17-year-old suspects does not identify a motive, but says the two teenagers bragged to friends about the shooting.

According to police, friends and acquaintances of the boys — whom The Associated Press is not naming because of their ages — said the suspects had been showing off a gun at the party, and had said to others that they had shot a man. At one point, the younger boy also said to a close friend at the party that he shot a “hobo” in the back.

The boys made one more stop at the scene to find Ross still alive, prompting the older boy to shoot him multiple times, according to the complaint.

“It’s completely disturbing,” said Officer Simon Drobik, an Albuquerque police spokesman, said Tuesday. “They just shot this guy for fun.”

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The Last Castro; Raul retires as Cuban president

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Raul Castro turned over Cuba’s presidency Thursday to a 57-year-old successor he said would hold power until 2031, a plan that would place the state the Castro brothers founded and ruled for 60 years in the hands of a Communist Party official little known to most on the island.

Castro’s 90-minute valedictory speech offered his first clear vision for the nation’s future power structure under new President Miguel Mario Diaz-Canel Bermudez. Castro said he foresees the white-haired electronics engineer serving two five-year terms as leader of the Cuban government, and taking the helm of the Communist Party, the country’s ultimate authority, when Castro leaves the powerful position in 2021.

“From that point on, I will be just another soldier defending this revolution,” Castro said. The 86-year-old general broke frequently from his prepared remarks to joke and banter with officials on the dais in the National Assembly, saying he looked forward to having more time to travel the country.

In his own half-hour speech to the nation, Diaz-Canel pledged to preserve Cuba’s communist system while gradually reforming the economy and making the government more responsive to the people.

“There’s no space here for a transition that ignores or destroys the legacy of so many years of struggle,” Diaz-Canel said. “For us, it’s totally clear that only the Communist Party of Cuba, the guiding force of society and the state, guarantees the unity of the nation of Cuba.”

Diaz-Canel said he would work to implement a long-term plan laid out by the National Assembly and communist party that would continue allowing the limited growth of private enterprises like restaurants and taxis, while leaving the economy’s most important sectors such as energy, mining, telecommunications, medical services and rum- and cigar-production in the hands of the state.

“The people have given this assembly the mandate to provide continuity to the Cuban Revolution during a crucial, historic moment that will be defined by all that we achieve in the advance of the modernization of our social and economic model,” Diaz-Canel said.

Cubans said they expected their new president to deliver improvements to the island’s economy, which remains stagnant and dominated by inefficient, unproductive state-run enterprises that are unable to provide salaries high enough to cover basic needs. The average monthly pay for state workers is roughly $30 a month, forcing many to steal from their workplaces and depend on remittances from relatives abroad.

“I hope that Diaz-Canel brings prosperity,” said Richard Perez, a souvenir salesman in Old Havana. “I want to see changes, above all economic changes allowing people to have their own businesses, without the state in charge of so many things.”

But in Miami, Cuban-Americans said they didn’t expect much from Diaz-Canel.

“It’s a cosmetic change,” said Wilfredo Allen, a 66-year-old lawyer who left Cuba two years after the Castros’ 1959 revolution. “The reality is that Raul Castro is still controlling the Communist Party. We are very far from having a democratic Cuba.”

After formally taking over from his older brother Fidel in 2008, Raul Castro launched a series of reforms that led to a rapid expansion of Cuba’s private sector and burgeoning use of cellphones and the internet. Cuba today has a vibrant real estate market and one of the world’s fastest-growing airports. Tourism numbers have more than doubled since Castro and President Barack Obama re-established diplomatic relations in 2015, making Cuba a destination for nearly 5 million visitors a year, despite a plunge in relations under the Trump administration.

Castro’s moves to open the economy even further have largely been frozen or reversed as soon as they began to generate conspicuous displays of wealth by the new entrepreneurial class in a country officially dedicated to equality among its citizens. Foreign investment remains anemic and the island’s infrastructure is falling deeper into disrepair. The election of President Donald Trump dashed dreams of detente with the U.S., and after two decades of getting Venezuelan subsidies totaling more than $6 billion a year, Cuba’s patron has collapsed economically, with no replacement in the wings.

Castro’s inability or unwillingness to fix Cuba’s structural problems with deep and wide-ranging reforms has many wondering how a successor without Castro’s founding-father credentials will manage the country over the next five or 10 years.

“I want the country to advance,” said Susel Calzado, a 61-year-old economics professor. “We already have a plan laid out.”

Most Cubans have known their new president as an uncharismatic figure who until recently maintained a public profile so low it was virtually nonexistent. Castro’s declaration Thursday that he saw Diaz-Canel in power for more than a decade was likely to resolve much of the uncertainty about the power the new president would wield inside the Cuban system.

“The same thing we’re doing with him, he’ll have to do with his successor,” Castro said. “When his 10 years of service as president of the Council of State and Council of Ministers are over, he’ll have three years as first secretary in order to facilitate the transition. This will help us avoid mistakes by his successor, until (Diaz-Canel) retires to take care of the grandchildren he will have then, if he doesn’t have them already, or his great-grandchildren.”

Cuban state media said Russian President Vladimir Putin congratulated Diaz-Canel and thanked Castro for the many years of cooperation between the two countries, while Chinese President Xi Jinping also reaffirmed his country’s friendship with Cuba and expressed interest in deeper ties.

At the U.S. State Department, spokeswoman Heather Nauert expressed disappointment at the handover, saying Cuban citizens “had no real power to affect the outcome” of what she called the “undemocratic transition” that brought Diaz-Canal to the presidency.

Vice President Mike Pence tweeted at Castro that the U.S. won’t rest until Cuba “has free & fair elections, political prisoners are released & the people of Cuba are finally free!”

Diaz-Canel said his government would be willing to talk with the United States but rejected all demands for changes in the Cuban system.

With Castro watching from the audience, Diaz-Canel made clear that for the moment he would defer to the man who founded the Cuban communist system along with his brother Fidel. He said he would retain Castro’s cabinet through at least July, when the National Assembly meets again.

“I confirm to this assembly that Raul Castro, as first secretary of the Communist Party, will lead the decisions about the future of the country,” Diaz-Canel said. “Cuba needs him, providing ideas and proposals for the revolutionary cause, orienting and alerting us about any error or deficiency, teaching us, and always ready to confront imperialism.”

Diaz-Canel first gained prominence in central Villa Clara province as the top Communist Party official, a post equivalent to governor. People there describe him as a hard-working, modest-living technocrat dedicated to improving public services. He became higher education minister in 2009 before moving into the vice presidency.

In a video of a Communist Party meeting that inexplicably leaked to the public last year, Diaz-Canel expressed a series of orthodox positions that included somberly pledging to shutter some independent media and labeling some European embassies as outposts of foreign subversion.

But he has also defended academics and bloggers who became targets of hard-liners, leading some to describe him a potential advocate for greater openness in a system intolerant of virtually any criticism or dissent. International observers and Cubans alike will be scrutinizing every move he makes in coming days and weeks.

As in Cuba’s legislative elections, all of the leaders selected Wednesday were picked by a government-appointed commission. Ballots offered only the option of approval or disapproval and candidates generally receive more than 95 percent of the votes in their favor. Diaz-Canel was approved by 604 votes in the 605-member assembly. It was unclear if he had abstained or someone else had declined to endorse him.

The assembly also approved another six vice presidents of the Council of State, Cuba’s highest government body. Only one, 85-year-old Ramiro Valdes, was among the revolutionaries who fought with the Castros in the late 1950s in the eastern Sierra Maestra mountains.

___

Associated Press writer Ben Fox contributed to this report.

 

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